A relatively small number of adults  the author of this book estimates the total at 5,000 - 10,000 in the United States  find it erotic to be dressed in diapers and plastic or rubber pants; to wet or soil those diapers; to be changed and powdered; to be put to bed in a crib; to drink milk and formula from a nippled bottle; to wear a bib while eating; to suck on a pacifier when in distress; and/or to engage in other behaviors typical of and unique to infants and toddlers. These people are devotees of psychosexual infantilism, which Thomas John Speaker defines as "sexual behavior with psychic and physical origin, involving sexual arousal from the behaviors and objects of infancy." Infantilism, he says, "can arise from either a fixation in development or a regression."

The term psychosexual infantilism was coined by Wilhelm Steckel, who regarded the predilection as a retreat from reality whose object was to become an eternal infant, free of responsibility but also constrained from psychological growth and development. The scant clinical literature concerning this condition describes a very disturbed individual who is likely to have had encounters with the law and to have been mandated to psychotherapy. In Patterns of Psychosexual Infantilism Steckel describes the infantilist as a

dependent person.... [whose] oral zone substitutes for the genital zone.... [who] has feelings of inferiority.... [who is likely to be] "impotent, frigid or [to] have no normal sexual relations ... males lose their erections when they contact women ... females become rigid or limp.... [who] are, as a rule, passive sexual partners.... [who] show a keen interest in urination and defecation ... and may go so far as to re-introduce enuresis and [encopresis].... These people glory in filth and dirt.... The day is passed in daydreams, idleness or childish games.

Using correspondence networks, and following up on his own master's
thesis, "Sexual Infantilism in Adults: Causes and Treatment," Speaker has sought to discover the infantilist's profile with more accuracy and less prejudice than Steckel brought to his interpretation. Speaker interviewed and administered several questionnaires to about 50 self-identified infantilists over the age of 21 years who had acted out infantilist fantasies as adults. Twenty-seven of those people completed the Infantalism Survey, and their responses form the research base for this book. Because Psychosexual Infantilism in Adults is based on such a limited set of responses, Speaker acknowledges that its conclusions cannot be taken as
definitive. Nonetheless, Speaker has performed real research in a nearly virgin field, and significantly expanded the sexological knowledge base there. In addition, from the beginning he appears to be sympathetic to his topic, sensitive to his respondents, and receptive to the possibility that psychosexual infantilism may not be so horrid a condition as Steckel thought it was.

Speaker begins by describing infantilist behavior as reported in follow-up studies of some people he had surveyed for his earlier work. Some describe the sheer joy they receive from sharing their pleasures with a partner; others describe the torment of losing important relationships when they disclosed their erotic desires. Some describe abusive childhoods with protracted histories of enuresis; others claim normal childhoods unremarkable in the events that contemporary psychologists look for in people with variant erotic tastes. Some people describe complementary variant practices, including a fondness for sadomasochism (SM), dominance and submission (DS), and fetishism; others claim no other non-standard interests. Some people describe infantilism as their only sexual release; others describe it as a form of foreplay. Some people feel infantilism has expanded their emotional lives; others feel guilty after each episode. One man, described as a pioneer in infantilism, claims to have placed the first personal infantilist ads in gay and counterculture magazines beginning in 1971.

In what was for me the book's most compelling chapter, Speaker discusses "The Infantilism Survey" and provides a profile of his "average' survey respondent."

He is male (better than 99% are) and about 38. He works a white collar job (management or professional). He is heterosexual and is married or living with a sexual partner. He has completed a bachelor's degree and some graduate courses. Looking at sexual preferences he enjoys dominance and submission (usually as a submissive). D & S activities will sometimes involve infantilism.... [He] is more likely to have been the oldest or youngest child than a middle sibling. He was not abused as a child and his parents treated him age appropriately. He was, however, enuretic.... until age 5.... he reached puberty at approximately the same age as peers, and had his first orgasm at age 12. He returned to diapers, by choice, by age 14.... Use of diapers has caused problems ... but therapy is seldom sought as a remedy.... Psychosexual infantilism is seen as a lifestyle....

Speaker compares his "average" infantilist with other people who enjoy variant sexual activities by using a Fantasy Questionnaire, including rubber fetishists, leather fetishists, sadomasochists, and transvestites. Although he concurs with other researchers that "variant groups are inclined to be less happy and fulfilled in their sex life" than people in control groups (which Speaker himself did not use), he notes that the need for a partner may occlude satisfaction in situations such as infantilism where partners often decline to participate.

Relying on definitions culled from Ginny Graham Scott's book Erotic Power, Speaker distinguishes between "natural" infantilists and "balancers." He sees naturals as people who "lean toward the more extreme aspects of the fetish," preferring to live as babies as much and as often as possible; balancers seem not only to have more latitude about whether and when they indulge their practices but also to have more flexibility regarding the option of playing mommy or daddy to other infantilists.

Musing on the reasons people develop into infantilists, Speaker holds with the classical conditioning model of learning, seeking to identify conditioning experiences in early childhood. He then claims there are many more men than women infantilists because men have a biological predisposition to develop fetishes: their sex organs are more susceptible to tactile stimulation; those organs are more obvious biofeedback mechanisms for determining arousal than womens' organs are; and males are traditionally thought to be more visually oriented than females (a belief that may, in time, turn out to be a cultural rather than a biological artifact), yielding a greater likelihood that they will respond to sensory cues of arousal.

I am greatly encouraged by Speaker's general approach to psychosexual infantilism because he seeks to redefine this and other non-standard sexual practices as "variant" rather than "deviant" or "pathological." He has researched this arcane field well, reading not only the few classical cases on the subject but also the contemporary magazines and newsletters where real people who are not case studies communicate with others who are like-minded. Indeed, his book is published (in Xerographic form) by one of the two pre-eminent newsletter publishers in the field, known as the Diaper Pail Friends (DPF).

I am also pleased that when he addresses the ways in which psychotherapy can help infantilists, he does not assert that it is a mode by which "ill" people can be "cured." He specifically notes that "Alteration or elimination of a fetish is a procedure fraught with difficulties; success rates are not high," and he recognizes that therapeutic regression can help an infantilist meet his needs.

The goal of any type of psychotherapy should be to open options from which the client can choose. In psychosexual infantilism, psychotherapy can serve to remove blocks to conventional scripts, to increase control over variant behaviors (so that acting out of the fantasy is by conscious and informed choice, not irrational compulsion) and to heal the emotional side-effects of having a variant script (guilt, anxiety, depression).

I am confused, however, that Speaker also seems to accept Patrick Carnes's notion that one can become addicted to sex, or to some sexual behavior, and that such "sexual addiction" is undesirable. As I read Carnes he has utterly refused to comprehend sexuality in exactly the way Speaker elsewhere seems to have accepted it. I am also puzzled by Speaker's assertion that variant erotic scripts "only become prominent as more conventional scripts are blocked." This position, which Speaker does not document or defend, is borne out neither by my personal nor my clinical experience, nor by the best literature I have read. It seems to me to be at odds with the whole thrust of Speaker's study and to weaken its force.